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Does Health Insurance Cover Orthopedic Surgery?

Published On Dec 09, 2021 12:00 PM By InsuranceDekho

Orthopedic concerns have been on the rise for the past few years. Although most of the treatment can be no-invasive, some extreme cases may require surgery. This has also led to increasing concern over whether orthopedic surgery is covered by health insurance. They can cost quite a lot and there are associated tests as well, which is why having a health insurance policy might be a good idea.

Does Health Insurance Cover Orthopedic Surgery?

What is Orthopedic Surgery?

Orthopedic surgery is usually performed on the hip, shoulders, knee, wrist and such areas of the human body. The surgery itself is performed on the skeletal and overlying muscular layer of the body. It is done to cure problems arising from genetic or acquired disorders as well as due to some acute injury or accident. Not only does the surgery account for treatment on the skeletal system of the human body, but also associated ligaments, tissues, tendons and such. Orthopedic surgery can either be open surgeries or might be carried out through arthroscopy. Some of the commonly performed orthopedic surgeries are arthroplasty, joint surgery, bone fracture repair, and many more.

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Costs Incurred Due to Orthopedic Surgery

Orthopedic surgery can rack up expenses, which is why it is important to look at health insurance policies for it. There are costs not only for the surgery itself, but also pre-hospitalization costs, consultation fees, medical tests costs, and more. Sometimes, you might even have to take a second opinion before you go ahead with the surgery, making the entire process quite costly. Moreover, there are various types of surgeries that all fall within the ambit of orthopedic surgery. However, not all of them cost the same. All in all, orthopedic surgery can be costly and definitely calls for assistance from a health insurance provider.

Does Health Insurance Cover Orthopedic Surgery?

Yes, most health insurance providers cover orthopedic surgery since it is considered to be a medical surgery. Not only the surgery costs but all associated expenses are usually covered by health insurance policies. There are common costs that are usually covered by health insurance policies such as nursing fees, ambulance fees, and more. Sometimes, orthopedic surgeries also include surgical implants which are often covered by health insurance policies as well.

For the surgery itself, health insurance policies might cover it completely or partially, depending on the scope of the policy and the sum that has been insured under it. Most health insurance policies do cover orthopedic surgery but have a waiting period. During the waiting period, the policyholder cannot make any claims against their health insurance policy even if it does cover the surgery they are going through. The waiting period might be anywhere from 1 to 2 years or more, depending on the type of surgeries it covers and the insurance provider. If it is a pre-existing condition, the waiting period is longer and can extend up to 4 years.


Orthopedic surgery is indeed covered by health insurance policies. However, as with all health insurance policies, the exact scope of the policy differs from one policy to another as well as on the insurance provider. Always remember to check the terms and conditions of a health insurance policy thoroughly to understand exactly what it covers and will provide for. Having a comprehensive health insurance policy that covers all concerns leads to hassle-free surgery and less financial strain at the hour of need.

Also Read: Benefits of Arogya Premier Policy Offered by SBI General Insurance Company

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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